MEASLES: Infection is via an aerosol route and the virus is very contagious. It replicates initially in the upper/lower respiratory tract, followed by replication in lymphoid tissues leading to viremia and growth in a variety of epithelial sites.

A typical case of measles begins with mild to moderate fever, cough, runny nose, red eyes, and sore throat. Two or three days after symptoms begin, tiny white spots (Koplik’s spots) may appear inside the mouth. Three to five days after the start of symptoms, a red or reddish-brown rash appears. The rash usually begins on a person’s face at the hairline and spreads downward to the neck, trunk, arms, legs, and feet. When the rash appears, a person’s fever may spike to more than 104 degrees Fahrenheit. After a few days, the fever subsides and the rash fades.

In 2000, the United States achieved measles elimination (defined as interruption of year-round endemic measles transmission). However, importations of measles into the United States continue to occur because it remains a common disease in many parts of the world, including areas in Europe, Asia, the Pacific, and Africa. The disease is brought into the United States by people who get infected in other countries. They spread the disease to others, which can cause measles outbreaks.

MUMPS: Mumps is spread by droplets of saliva or mucus from the mouth, nose, or throat of an infected person, usually when the person coughs, sneezes, or talks. Items used by an infected person, such as soft drink cans or eating utensils can also be contaminated with the virus, which may spread to others if those items are shared. In addition, the virus may spread when someone with mumps touches items or surfaces without washing their hands and someone else then touches the same surface and rubs their mouth or nose.

Up to half of people who get mumps have very mild or no symptoms, and therefore do not know they were infected with mumps. The most common symptoms include: fever, headache, muscle aches, tiredness, loss of appetite, swollen and tender salivary glands under the ears on one or both sides (parotitis)

As with all vaccines, there are some individuals who will not gain immunity after receipt of mumps vaccine. Because vaccine effectiveness is not 100%, a second dose of mumps containing vaccine is recommended during outbreak situations for individuals who have received only one dose previously. Studies have shown a trend toward a lower attack rate among children who have received two doses of mumps vaccine as opposed to those who have received one dose.

RUBELLA: Rubella, also called German measles, is a viral illness that is spread from person to person by breathing in droplets of respiratory secretions exhaled by an infected person. It also may be spread by touching the nose or mouth after a person’s hands has been in contact with secretions (such as saliva) of an infected person.

Usually presents as a nonspecific, maculopapular, generalized rash that lasts ≤3 days with generalized lymphadenopathy. Rash may be preceded by low-grade fever, malaise, anorexia, mild conjunctivitis, runny nose, and sore throat. Asymptomatic rubella virus infections are common. Infection during early pregnancy can lead to miscarriage, fetal death, or severe birth defects known as congenital rubella syndrome.

In October 2004, CDC convened an independent panel of internationally recognized authorities on public health, infectious disease, and immunization to assess progress toward elimination of rubella and congenital rubella syndrome (CRS) in the United States. They found that 1) fewer than 25 reported rubella cases each year since 2001 2) at least 95% vaccination coverage among school-aged children, 3) estimated 91% population immunity, 4) adequate surveillance to detect rubella outbreaks, and 5) a pattern of virus genotypes consistent with virus originating in other parts of the world. Given the available data, panel members concluded unanimously that rubella is no longer endemic in the United States.

VARICELLA ZOSTER: Chickenpox can be spread very easily to others. You may get chickenpox from touching the fluids from a chickenpox blister, or if someone with the disease coughs or sneezes near you. Even those with mild illness may be contagious. Varicella is less contagious than measles but more so than mumps and rubella.

VZV remains in a latent state in human nerve tissue and reactivates in approximately one in three infected persons during their lifetime, resulting in herpes zoster. Herpes zoster usually presents as a vesicular rash with pain and itching in a dermatomal distribution. Herpes zoster incidence increases with increasing age, especially after age 50, is more common among immunocompromised persons, and among children with a history of intrauterine varicella or varicella occurring within the first year of life; the latter have an increased risk of developing herpes zoster at an earlier age.

The rash is generalized and pruritic (itchy). It progresses rapidly from macules to papules to vesicular lesions before crusting. The rash usually appears first on the head, chest, and back then spreads to the rest of the body. The lesions are usually most concentrated on the chest and back.

Although increased vaccination of children has lowered the overall burden of disease, a higher proportion of reported cases now occur among older children, adolescents, and adults who may have escaped varicella disease or vaccination. As vaccination rates have increased, the majority of varicella cases now occur among vaccinated persons. Cases of varicella in vaccinated persons (i.e., breakthrough cases) are generally much milder, often with fewer than 50 lesions and fewer vesicles compared with 300 or more lesions and many vesicles typically seen in unvaccinated persons. Persons with breakthrough cases are also less likely to have fever and more likely to have fewer days of illness.

PREVENTION:Measles, Mumps, Rubella, and Varicella (MMRV) viruses are all vaccine preventable diseases. Acquired immunity after illness is also permanent.

There are two vaccine protocols approved in the US. There is a MMR (measles, mumps, and rubella) vaccine administered to children beginning at 12 months of age along with a separate varicella vaccine. Susceptible hospital personnel, volunteers, trainees, nurses, physicians and all persons who are not immune should also be vaccinated. Women who are pregnant or intend to become pregnant within three months, however, should not receive rubella vaccine.

There is also a vaccine available that is made up of measles, mumps, rubella, and varicella (chickenpox) components (MMRV). It is a single shot that can be used in place of the two other shots--the measles, mumps, and rubella (MMR) vaccine and the varicella vaccine.

The vaccines should be given in two doses. The first dose should be given when the child is 12 - 15 months old. A second dose should be given when they are 4 - 6 years old.

A zoster vaccine is also licensed and recommended for adults 60 years of age and older in the United States.